Financial Toxicity of Hematologic Malignancy Therapies, Including Cellular Therapy and Its Impact on Access to Care - Prospective Pilot Study

Sep 29, 2026

Patients with cancer often experience financial toxicity (FT), a condition linked to reduced quality of life, with hematologic malignancies facing heightened vulnerability from intensive, prolonged regimens, frequent visits, and treatment-related complications. This prospective pilot study assessed FT severity in a socioeconomically underserved US population receiving therapy for hematologic malignancies, examined sociodemographic predictors, and captured patients’ subjective experiences tied to financial burden through validated COST-FACIT measures over 90 days.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusions

Introduction

Context of cancer and financial toxicity

Keywords

JMIR CANCER Amaeshi et al Original Paper Financial Toxicity of Hematologic Malignancy Therapies, Including Cellular Therapy and Its Impact on Access to Care: Prospective Pilot Study | Lemchukwu Amaeshi 1,2 , MD; Lauren Laufer1,3 , BA, MD; Kateryna Fedorov4,5 , MD; Alex Sisto 1,6 , MD; David Levitz4 , MD; Rosmi Mathew 1 , DNP, APRN, FNP-BC; Karen Wright 1†, RN, MS; Dennis Cooper4 , MD; Mendel Goldfinger4 , MD; Ioannis Mantzaris4 , MD; R Alejandro Sica4 , MD; Kira Gritsman4 , MD, PhD; Marina Konopleva4,7 , MD, PhD; Ridhi Gupta4 , MD; Noah Kornblum4 , MD; Chenxin Zhang2 , MS; Mimi Kim2 , SCD; Amit Verma4 , MD; Bruce Rapkin 1,2 , PhD; Aditi Shastri4 , MD; Nishi Shah4 , MD, MPH | | --- | | 1Department of Medicine, Montefiore Medical Center, Bronx, NY, United States 2Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States 3Department of Medicine, University of California, Los Angeles, CA, United States
4Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States 5Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
6Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States 7Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States †deceased
Corresponding Author:
Nishi Shah, MD, MPH Department of Oncology
Montefiore Medical Center and Albert Einstein College of Medicine
111 E 210th St Bronx, NY 10467 United States
Phone: +1 (404) 778-1900
Email: [dr.nishi.n.shah@gmail.com](dr.nishi.n.shah@gmail.com)
Abstract | Background: Patients with cancer often face significant financial challenges, known as financial toxicity (FT), which is associated with reduced quality of life. Patients with hematologic malignancies (HMs) are especially vulnerable due to intensive and prolonged treatments, frequent hospital visits, and a high risk of complications. While FT affects many in the general population, it is particularly severe among racial and ethnic minorities, especially those below the poverty line. To our knowledge, no studies have specifically examined FT in this vulnerable group in the United States. Objective: This study aimed to evaluate the severity of FT in patients receiving treatment for HMs in a socioeconomically underserved population, explore sociodemographic factors that may predict the severity of FT, and evaluate the subjective experiences of these patients as they relate to FT. Methods: We conducted a prospective, observational, longitudinal study at the Montefiore Cancer Center’s outpatient department in the Bronx, New York, from October 1, 2022, to October 30, 2023. Participants included either adult patients newly diagnosed (ND) with HMs or those already diagnosed, undergoing cellular therapy (CT) . The severity of FT was assessed using the validated Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) questionnaire. Additionally, an investigator-designed questionnaire was developed to gather sociodemographic data and evaluate the subjective effects of financial burden on patient care . Patients in both the ND and CT groups were followed for 90 days. Data collection occurred at their initial presentation, as well as on days 30 and 90. Results: Ninety patients participated in the study (ND=52 and CT=38) . The median age was 59 (IQR 44-66) years, with 27%(n=24) African American and 55%(n=48) Hispanic. Overall, 75%(n=67) of participants experienced some degree of FT, most with mild FT at baseline (day 0, median COST-FACIT score=19.4) . In the CT group, FT worsened significantly overtime, with a decline in median COST-FACIT scores from 19.9 at day 0 to 15.5 on day 90 (P= .02) . In a multivariable linear regression model, race and ethnicity were a significant predictor of FT burden: identifying as African American or Hispanic [https:

FAQs

What does “financial toxicity” mean in this study?

Financial toxicity refers to psychological, material, and behavioral hardships driven by the economic burden of cancer care. In this paper it is measured using the COST-FACIT questionnaire.

How was financial toxicity severity assessed for patients with hematologic malignancies?

Severity was evaluated with the validated Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT). Patients were followed for 90 days with data collected at baseline, day 30, and day 90.

Which patient groups showed worse financial toxicity burden?

Race and ethnicity were significant predictors. Identifying as African American or Hispanic was associated with a lower COST-FACIT score (higher FT) compared with non-Hispanic White participants, and FT prevalence was high across participants.

Sep 29, 2026

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